Medicare-certified home health services: national and regional supply in the 1980s.

The number of Medicare-certified home health agencies nearly doubled from 1980 to 1990. Using Health Care Financing Administration data, this study documented national and regional patterns of entry and exist by Medicare home health providers from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980s and then dropped abruptly in the second half of the decade. The proprietary sector, accounting for approximately 42% of agencies in existence during the period of the study, exhibited the greatest volatility. Regional differences are also evident. Both expansion and contraction in Medicare home health services appear to be a response to the incentives of legislation implemented during this period.

Growth and decline in the supply of providers of Medicare-covered home health services in the 80's: national and regional experience.

Using Health Care Financing Administration (HCFA) data, this study documents national and regional patterns of market entry and exit in the home health industry from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980's, then dropped abruptly in the second half of the decade. The for-profit sector exhibited the greatest volatility. Of the 3,620 proprietary agencies in existence during the decade, 3,284 (90.7%) were new entrants, and 1,551 exited the market by 1990. Regional differences in growth rates and the timing of market entry are also evident. Both growth and decline in the home health industry appear to be a response to the incentives of legislation implemented during this period.

Analysis of job functions of top level nurse executives in acute, home, and long-term care: implications for education.

The purpose of this study was to strengthen the empirical base for nursing administration curricula by analyzing the current job functions of top level nurse executives in acute, long-term, and home care settings. The survey of job functions was designed to identify the relative amount of "time spent" and "importance" attributed to the job activities of nurse executives. Course content areas providing preparation for key job responsibilities are identified, and recommendations for curriculum design are discussed.

Future preparation of occupational health nurse managers.

This article presents the results of a national survey of job activities of corporate level occupational health nurse managers. The survey was designed to identify the relative amount of time spent and importance attributed to specific areas of their current job. In general this sample tended to have more management experience and educational preparation than previously cited studies: over 50% had completed a graduate degree. The scores for importance and time spent were highly correlated. That is, occupational health corporate nurse managers seemed to allocate their time to job responsibilities they considered most important. Management activities related to policy, practice standards, quality assurance, staff development, and systems for client care delivery appear to represent the core responsibilities of occupational health nursing management. Curriculum recommendations for management positions in occupational health include: health policy, program planning, and evaluation; business strategy; applications of management information systems; quality assurance; and marketing.

Closures and mergers of VNA home care agencies: a model for the study of causal factors.

Recent closures and mergers of visiting nurses associations (VNAs) raise some potentially serious questions regarding access to home care for the elderly Medicare and Medicaid populations. While VNAs comprise less than 10 percent of the nation's certified home health agencies, they provide approximately 31 percent of all medicare home care (HCFA, 1989). In March of 1986 there were 524 visiting nurses associations nationally whereas today there remain only 495 (HCFA, 1990). A model identifying potential causes of VNA mortality is presented along with some preliminary results. VNA mortality is defined and measured by the date that Medicare certification is terminated as a result of VNA closure or merger.

Future preparation of home health nurse executives.

The responsibilities of home care nurse executives were investigated. A 51 item survey developed by an expert panel was completed by 54 home care nurse executives in Pennsylvania and New Jersey. Respondents evaluated the importance and time spent on each activity. A second expert panel identified where each activity is usually taught in an interdisciplinary curriculum. Based on the survey results, recommendations for graduate education for home care nurse executives were developed, emphasizing course content in the areas of law and policy, financial management, marketing, quality assurance, and organizational behavior.

Empirically based recommendations for content of graduate nursing administration programs.

Scalzi and Wilson use consensus research as a basis for determining content for graduate programs in nursing administration. They ask, what do practicing nurse executives do on the job? One hundred and eighty-four nurse executives from acute care, home care, long-term care, and occupational health rated and ranked their job functions.

Dual degree. Future preparation for nurse executives?

What is the best educational preparation for top-level nurse executives? Which educational degrees will improve marketability? These questions were asked of nurse executives and their chief executive officers in a national market survey. The authors discuss the results of the survey which provides information that may be useful in selecting educational programs and in planning and revising graduate curriculum.

Limitations and alternatives: ethical practice theory in nursing.

Limitations in findings are encountered when a theoretical framework is selected prematurely to guide theory building. Kohlberg's theory, chosen by Ketefian as the framework for an ethical practice theory of nursing may not reflect the life experiences of nurses. While Kohlberg's theory calls for an ethic of justice, Gilligan's research suggests that most women make ethical decisions based on an ethic of care. An alternative to the premature selection of a guiding framework is first to describe the moral decision making of nurses and then to choose the framework that best fits the reality of nursing.

Role stress and coping strategies of nurse executives.

Role stress among top level nurse executives has been linked to adverse personal effects. A study was conducted to better understand role stress and to assess the coping strategies used by top level nurse executives. The author discusses four major factors--overload, quality of care concerns, role conflict, and role ambiguity--related to role stress and ten coping strategies. Awareness of these issues can help the nurse executive to understand the job stresses inherent in the role and to use constructive methods of coping with that stress.

Role stress in hospital executives and nursing executives.

Two recent studies report for the first time on role stress in hospital executives--those in general administration and those in top nursing positions. Analysis reveals some similarities and differences, which provide insight into the difficult jobs of these executives.

Sexual therapy of patients with cardiovascular disease.

Physical illness or disability inevitably has a damaging effect on sexual relationships. Physicians are usually unaware of the sexual consequences of illness on their patients, and lack experience in treating sexual dysfunctions. The report of treatment of a couple with serious cardiovascular disease illustrates the potential efficacy of brief sex therapy for improving the quality of a patient's life. If a primary physician lacks the skills to conduct sex therapy, he may collaborate with nonphysician therapists. The physician's knowledge of the physiological and psychological effects of a specific illness on his patient is essential to successful therapy. Often, simple education, encouragement or reassurance by the physician is enough to overcome the damaging effects of illness on a patient's sex life.